The latest from the Romney campaign is that the President is “robbing” $716 billion from Medicare. Kate Pickert has put the lie to that here. And I must say, I’m outraged by the bald baloney-slicing Romney is attempting. It goes back to the cover story I wrote about the deaths of my parents. Romney and Ryan want to take the country in the precise opposite direction from sanity when it comes to end of life issues.

As Kate has written in the past, the bottom line on the cost reductions in the Romney-Ryan and Obama Medicare packages is pretty much the same. The question is, how do you get there? Romney-Ryan relies on mythology, the notion that a “free” market in Medicare will reduce the costs (and will reduce government spending by $6400 per senior citizen on average in anticipation of these efficiencies). But we’ve had an experiment in private Medicare delivery the past few years. It’s called Medicare Advantage and, as Kate has reported, it costs, on average, 14% more than standard fee-for-service Medicare.

Obama gets his many of his reductions by eliminating the bonuses to private insurers that participate in Medicare Advantage. He would also reduce some payments to hospitals. But the most important reforms in the Affordable Care Act have to do with the wasteful fee-for-service nature of Medicare as it now stands. Obama promotes electronic record keeping and reviews best medical procedures to see what really works and what’s really wasteful. He also encourages medical group practices to see how much money they would save–and allows them to keep some of those savings–if they try a “team” approach where doctors are paid salaries instead of paid for each test and procedure they perform.

It is impossible to know how much these reforms will save. “The Congressional Budget Office didn’t give us very much on the scoring here, since it’s something new,” an Administration Official told me. But the savings could be significant, if the results from the Geisinger Medical group in Pennsylvania are any gauge–a 10% reduction in cost, perhaps. (Of course, Romney would mischaracterize this as a cut).

But the more important consideration here is that the President’s plan is a far more humane way of going about the business of end-of-life medicine, as I found when Geisinger took over, and coordinated, the care of both my parents. As I wrote in June, I was made to feel part of a team, apprised of each new development as my parents declined, without having to chase down and organize the various specialists who’d been treating them. This is the model toward which Obamacare is pointing.

The Republicans hate it. Their answer, which–like supply-side economics–has proven to be an utter failure (see Medicare Advantage above) is to inject market discipline into the process. Let the elderly choose their health plans, let the plans compete for customers. I’m all for market disciplines and choice. It might not be a bad idea to extend the choices that will be part of Obamacare to people up to the age of 75. But there has been zero evidence that markets make much of a difference when it comes to elderly care. And I would have hated to watch my proud, but addled, father trying to make a wise choice in a market that is extremely complicated. (And believe me, he would have insisted on making that choice, even though he couldn’t hold a thought from one moment to the next.)

Maybe it’s because I’ve just been through a very painful experience, but the Republican flummery on this issue hits me harder than any position taken by either party on any other issue. This is a case of common decency. We really need to respect, and care for, our elders–and also our children who will be elderly when many of these reforms are enacted.

Buying an insurance policy does not inject market discipline into medicine. As long as the patients don't know what anything in a visit will cost until after the insurance is paid, there won't be a "free market" in medicine. The concept of competition without any way to pre-determine cost is a joke. The provider bills the patient some outrageous amount, the insurance company pays a small portion based on some contract, or what is customary, and the patient is left wondering what the hell did this really cost. I can't imagine how an uninsured person deals with the bills that result from a hospitalization except thru bankruptcy.

I work in the medical field, and having worked with the Advantage plans. I agree they should be eradicated. They are not cost effective, nor do they provide good medical care. I have seen many Advantage plans in my area (TX) that do not have doctors or facilities contracted with them, yet they still sell their plans to the elderly in the area. The patient must either pay a large deductible before the plan begins to pay, or sometimes plans will not pay anything to a non-contracted provider . The Senior citizens often do not understand the coverage they have with the Advantage plans or even with insurance supplements they purchase. In fact many patients who are not elderly, do not understand their insurance coverage or how it pays. It is no wonder it is confusing for our elderly.

I have watched the cuts in covered medicare services the last few years. I agree that medicare program needs to be improved and be cost efficient. I do not like it being at the cost of treatment of our elderly. For reference, here is a list from the CMS ( this is the Gov medicare) site of the revised and deleted IDC 9s and 10s. ( IDC 9 and 10 are universal diagnosis codes/numbers that identify the type of injury or illness a patient has) http://www.cms.gov/Medicare/Co...

You can also look on site for the hcpcs ( procedure/treatment) codes that have been removed, as well you are able to see the frequency of visits for some illnesses/treatments have also been reduced.

I work with both private insurance and the Gov medical coverages (champs, medicaid, medicare, chips and PCIP). I am extremely knowledgeable of them and their coverage. It is fact and sad that the private insurances still provide the best medical treatment for patients.

Congratulations to Mitt Romney! His signature contribution to American life, devising a health plan that became a model for the only major Western democracy without medical care for nearly all of its citizens, has been upheld. If Romney accomplishes nothing else in life, he will go down in history as the man who first proved, in the laboratory of Massachusetts, where he once governed, that an individual mandate could work.

Jeers to Mitt Romney! As the presumptive Republican nominee for president, he stood in front of the Capitol just after the Supreme Court ruling on Thursday and promised to fight in the coming campaign against one big idea — his own.Now Romney has no choice but to run against himself. It was Rick Santorum who put it in blunt political terms during the Republican primary. Romney, he said, “is the worst Republican in the country to put up against Barack Obama” because he is the intellectual godfather of the most consequential act of the Obama presidency.

If Romney was honest, and his party less locked in the grip of its far-right base, he could point with pride to the progress that Massachusetts has made. In the Bay State, compliance with the law is high, and nearly two-thirds of the people support it. The cost of insurance fell significantly in the first year after the law took effect. And fewer than 1 percent of the people chose to pay the penalty — or tax, as Chief Justice John G. Roberts Jr. helpfully clarified for Obamacare — rather than sign up for health insurance.But the days of Romney praising his plan, which he did as recently as 2009, are long gone. Remember, it was in a moment of debate candor that Romney turned to Newt Gingrich and acknowledged the free-market, Republican origins of the mandate.“We got the idea from Newt,” said Romney. “And Newt got it from the Heritage Foundation.” And the idea is a simple one: freeloaders cost the system billions and indirectly raise insurance for those who do the right thing.

If you expect any of them to be honest,you need to have your head checked.Both parties are out for them selves.If The dem's really wanted to help the middle class it should use all the money's collected for the elections amp; donate it to folks losing their job's; can't afford that over priced oil Obama promotes, by his hostile policy's towards it.That money would do more then his hope and change promise.lets face it tell the truth to our selves for once, both sides campaign cash would do a-lot more for folks then either candidates half baked empty promises would do.None of these idiots can or will do 30% of what they promise.Obummer has done 30% of what he said he'd do,if you did that at work you'd be fired.This country's full of folks who just don't get it anymore both party's went Hollywood putting their personal beliefs first amp; why they were put in office dead last.Nothing will change in either party, until these a-holes get ousted aggressively amp; with the utmost prejudice.

Amazing your addled and decrepit parents as you state in your time article are being presented choices Which is it , this or time comments that claims this is inhuman? Once again you are commenting on a plan that (Ryan) that is a proposal not a fact. Dont scream until wounded. Budjets are also referred to and you claim w/o proof or quoted athuority that Gov Romney said hed get around to it. Better than a illegal presidential directive , bet the budjet is submitted as it should be by law, within the constitution terms not when if ever the Demos do one .

You cant be all things to all people, even god has a problem here ,perhaps he should take lessons from a community organizer. Bet that pres. Romney wont call Isreals leader a liar in agreement with with Putin. God help Isreal if O/B is pres. and Syria attacks

Obamacare -- the devil is in the details. Can't tax and spend forever. I'm not a Democrat or a Republican--can't stand the rhetoric on both sides. Premiums will rise for everyone, including people on medicare. People with NO CHOICE in the care they receive is a sign of disaster. Some people can only afford castastrophic insurance but that changes under Obamacare. The government will tell you what BASIC coverage you have to carry and for many, that basic coverage is more coverage than what they currently receive. And as we all know, that doesn't come free. Taxpayers will pay.

Obama has to radically change for him to win my vote but that won't happen, not in my live time. It would be refreshing if he'd just tell the truth and not pander to the big labor groups, minority interests and freeloaders. I can say that since I'm an Asian-Pacific Islander and was raised by my mother who was a teacher. My brothers and I were raised to get an education, work hard and be self-supporting. When my parents divorced, she didn't receive any support from him nor did she receive any government aid. We all worked while going to school, graduated from college, retired and still working.

Under the Ryan Plan, if you are retired, your Medicare coverage will NOT change.

If you are over 55, Medicare as it exists today will be there for you when you retire.

And the Ryan Plan provides for quality health insurance coverage upon retirement for

those currently under 55.

It is important that we…

Maintain availability of insurance coverage for future retirees

Since individuals generally require more medical care as they age, it tends to be difficult for older individuals to find private health insurance that will cover them. That is one reason our existing Medicare system is considered so important for many. The Ryan Plan creates risk pools which encourage multiple insurance companies to offer health coverage to those of retirement age.

It is important that we…

Maintain affordability

Individuals have paid into the Medicare system with the promise that coverage will be there for them when they retire. Unfortunately, we are facing an economic crisis in this country and Medicare is a significant part of the problem. To save the system for everyone and to avert broader economic calamity, in the future wealthier Americans will have to bear a greater portion of their healthcare burden.

It is important that we…

Make it feasible for doctors to participate in Medicare

Currently in many areas of the country physicans are reimbursed for Medicare patients at a rate that does not cover their expenses. Recent changes put forth by the Democrats further reduce reimbursement. [cite] This is not sustainable for any business and as a result increasing numbers of physicians are discontinuing their participation in the Medcare program. Patients are finding that their physician is no longer a Medicare provider and when they look for another physician it is increasingly difficult for them to find a Medicare provider who is accepting new patients and can see them in a reasonable time. [cite]. The Ryan plan fixes the reimbursement problem, making it feasible for physicians to continue participating in Medicare.

It is important that we…

Keep medical decisions between patients and doctors, not remote government panels

The Ryan plan harnesses the free market and puts choice in the hands of the patient. Retirees will be able to pick the insurance plan that best meets their needs, applying government vouchers toward premium costs. Medical decisions would be made in consultation with their personal physician, based on the individual’s situation and preferences.

I've been watching elections for over 50 years. I've never seen a campaign more dishonest than Romney's.

The Voters Rights Act passed in 1965. It's shocking to see Republicans concerted effort suppress the vote via voter ID, variable voting hours and other devious methods when there's negligible evidence of voter fraud. It's a disgrace by people claiming to treasure the intent of the founding fathers and the constitution. The flaws in the accuracy and tamper-proofing of the voting machines hasn't been addressed either. So the electorate is exposed such that the will of the people may get suppressed.I'm left hoping the media will do it's job as democracy's arbiter for the truth. But the massive spending on advertising by the Romney campaign via the appalling Citizens United decision to perpetuate this dishonesty is being funded by many billionaires who also own media companies. It's a frightening situation.

Maybe I've just been naive all these years or too trusting as I never thought I'd see the day when the government of the United States of America might be for sale to such a dishonest group.

Thanks for your article, Joe. I hope there are more like you in the media who can and will stand up to this. If they pull it off, "I want my country back" will have a whole new and very sad meaning.

This is an open letter to Americans who are still open to input on their votes.

No matter where you stand, get energized. The 2012 election is the most important one that we have had in this country in decades. It will define who we are for years to come.

I am sick of people saying one party or other is trying to divide the country. The country already IS divided, it has been for awhile, and the two candidates just reflect that divide. The battle is over who can persuade the small remaining cache of voters still trying to figure out their priorities. The candidates are trying to (a) define those priorities for them, and (b) feed them with enough BS to develop their opinions as to who best meets them.

Make no mistake, this election isn't about debt, taxes, or wars. It's an ideological fight. One side wants the free market to dictate all, and the other side thinks government does a better job supporting people who need it. Given the chance, the Republicans will mow down social programs and let the market decide who wins and loses, but they will also lower revenue and increase defense spending so the deficit isn't getting cut anytime soon under their plans. The Democrats will do the opposite, equipping government to intervene in the market so spending isn't decreasing, but revenue will to an extent. And the deficit isn't getting cut anytime soon under their plans either.

Neither side is "wrong" necessarily, they just reflect two different visions of what the country should be. Is profit deciding who gets what, or is it the government? That's the stark choice we face. To me, it's a question of whether you want this country to lean toward capitalism or socialism (which is NOT a bad word) - whether we're a nation of people who look out for themselves, or a nation of people who look out for one another.

As a citizen I plead with you to set your priorities correctly and ignore the fringe "noise" that interferes with recognition of this choice...gay marriage, abortion, etc. They may be issues that are important to you, but they should not be the sole driver of your choice of president and vice president and the administration you'll get (which unfortunately doesn't get defined until after someone is elected). The two sides' stances on these issues aren't even consistent with their broader perspectives (how exactly is prohibiting gay marriage NOT a government intrusion on freedom, I'd like to know, and how is it not promoting religion as policy driver for what should be a civil issue). Boil it down...does money come first, or do the people?

I try to remain objective in considering the future of this country and educate myself on the merits of both perspectives. But my Catholic-based values, on which I place the highest priority on social justice and standing up for those less fortunate (at home and abroad) mean I can't justify a Republican vote. The Democrats aren't perfect either, but they better reflect what I personally hope this country stands for...focused on "us" vs. "me".

Please arm yourself with facts about the implications of these two parties. Don't let them define terms for you, or "inform" you with 30-second sound bites. It's too important.

And if all else fails...get to know the Green platform, and vote for Jill Stein.

If you don't want to give your money to obese, cigarette smoking, alcohol swigging, lottery ticket buying people on welfare, you can try Catholic Relief Services. The money goes to starving and dying people in third world countries.

Obama's plan is a DEFINED BENEFIT PLAN, where you get certain specific benefits, as is the case with Medicare today. Romney/Ryan's plan is a DEFINED CONTRIBUTION PLAN, where you get $x to buy insurance from an INSURANCE COMPANY and they decide what benefits you get. People, please educate yourself and get the facts. If government doesn't define your health benefits, good luck. Do you seriously believe that if you leave it up to for-profit insurance companies, they are going to be deciding what's in YOUR best interest, or THEIR best interests (i.e., profits.) Insurance companies have been some of the most profitable companies in this bad economy. Do you think they got that way by paying claims?

What a total piece of journalistic crapola! From the 'picture' of 'Romney' to the 'mythology' that private enterprise is more efficient than govt squanderings, this is a hit piece and should - and will be - ignored by anyone with a brain.

Joe Klein is a celebrated example of the fast that free speech is a good thing in that it makes the idiots much easier to spot.

Ever notice how, rather than refuting statements in articles like these point by point, the paranoiac wing of the right wing dismisses them outright as "lies", usually accompanied by some inflammatory accusation or conspiracy theory? It's as predictable as the tides. I can empathize on some level, I guess--thinking for yourself is hard work. Much easier to let the demagogues do it for you and lead you around by the nose.

That jack Mormon ram Midwest Utah jackrabbit is moving in fast on thowes votes yet the Midwest jungle bunny jackrabbit juice is fast to yet who to vote for?if a tertul entered the race from Bmorecity I would know so fast this voting race could be seen as a race war.pnm.

The left is lying once again, and the media is in on it. Medicare is going BROKE in less than 15 years. Something has to be done now. Lying about what is really happening will not fix the problem, Democrats. When it goes belly up we will BLAME YOU.